Vandervoort An, Houttekier Dirk, Van den Block Lieve, van der Steen Jenny T, Vander Stichele Robert, Deliens Luc
End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium.
End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium.
J Pain Symptom Manage. 2014 Feb;47(2):245-56. doi: 10.1016/j.jpainsymman.2013.03.009. Epub 2013 Jun 21.
Advance care planning (ACP) is key to good palliative care for nursing home (NH) residents with dementia.
We examined the extent to which the family physicians (FPs), nurses, and the relative most involved in the resident's care are informed about ACP, written advance directives, and FP treatment orders (FP-orders) for NH residents dying with dementia. We also examined the congruence among FP, nurse, and relative regarding the content of ACP.
This was a representative nationwide post-mortem study (2010) in Flanders, Belgium, using random cluster sampling. In selected NHs, all deaths of residents with dementia in a three month period were reported. A structured questionnaire was completed by the FP, the nurse, and the patient's relative.
We identified 205 deceased residents with dementia in 69 NHs. Residents expressed their wishes regarding end-of-life care in 11.8% of cases according to the FP. The FP and nurse spoke with the resident in 22.0% and 9.7% of cases, respectively, and with the relative in 70.6% and 59.5%, respectively. An advance directive was present in 9.0%, 13.6%, and 18.4% of the cases according to the FP, nurse, and the relative, respectively. The FP-orders were present in 77.3% according to the FP, and discussed with the resident in 13.0% and with the relative in 79.3%. Congruence was fair (FP-nurse) on the documentation of FP-orders (k=0.26), and poor to slight on the presence of an advance directive (FP-relative, k=0.03; nurse-relative, k=-0.05; FP-nurse k=0.12).
Communication regarding care is rarely patient driven and more often professional caregiver or family driven. The level of congruence between professional caregivers and relatives is low.
预立医疗照护计划（ACP）对于患有痴呆症的养老院（NH）居民获得良好的姑息治疗至关重要。
我们调查了家庭医生（FPs）、护士以及参与居民护理的最主要亲属了解NH中临终痴呆症患者的ACP、书面预立医嘱和FP治疗医嘱（FP-orders）的程度。我们还研究了FPs、护士和亲属在ACP内容方面的一致性。
这是一项于2010年在比利时弗拉芒地区进行的具有代表性的全国性尸检研究，采用随机整群抽样。在选定的NH中，报告了三个月内所有痴呆症居民的死亡情况。FPs、护士和患者亲属填写了一份结构化问卷。
我们在69家NH中确定了205名已故痴呆症居民。根据FPs的说法，11.8%的病例中居民表达了其关于临终护理的意愿。FPs和护士分别在22.0%和9.7%的病例中与居民交谈，分别在70.6%和59.5%的病例中与亲属交谈。根据FPs、护士和亲属的说法，预立医嘱分别出现在9.0%、13.6%和18.4%的病例中。根据FPs的说法，FP-orders出现在77.3%的病例中，与居民讨论的比例为13.0%，与亲属讨论的比例为79.3%。在FP-orders的记录方面，一致性一般（FPs-护士，k=0.26），在预立医嘱的存在方面，一致性较差至一般（FPs-亲属，k=0.03；护士-亲属，k=-0.05；FPs-护士，k=0.12）。
关于护理的沟通很少由患者驱动，更多时候是由专业护理人员或家庭驱动。专业护理人员和亲属之间的一致性水平较低。
